Prapassaro Tossapol, Teraa Martin, Chinsakchai Khamin, Hazenberg Constantijn E V B, Hunnangkul Saowalak, Moll Frans L, van Herwaarden Joost A
Faculty of Medicine Siriraj Hospital, Division of Vascular Surgery, Department of Surgery, Mahidol University, Bangkok, Thailand.
Department of Vascular Surgery, University Medical Center Utrecht, Utrecht, The Netherlands.
Ann Vasc Surg. 2022 Feb;79:359-371. doi: 10.1016/j.avsg.2021.08.013. Epub 2021 Oct 16.
To provide an overview of the literature on the mid-term outcomes of chimney EVAR (ChEVAR) for the treatment of juxtarenal abdominal aortic aneurysms (JAAA).
Different electronic databases were searched for published articles up to January 2020. The eligibility criteria were studies describing mid- or long-term outcomes of chimney EVAR (mean follow-up at least 1 year) for treatment of JAAA, including more than 10 cases, published in English, and with full text available. The outcomes measure were overall survival rate, target vessel patency, and freedom from reintervention at 3 years. Quality of the included studies was analyzed using the MINORS criteria. Pooled effect estimates were analyzed using random-effect models and heterogeneity was tested using I statistics.
Thirteen articles met the inclusion criteria. The included studies described 1,019 patients. According to the quality assessment, methodological quality was moderate to poor. The pooled overall survival, freedom from reintervention, and target vessel patency at 3 year was 81.4 % (95%CI 73.8-87.9), 85.7% (95%CI 75.6-93.5), and 95.1% (95%CI 89.3-98.7) respectively.
The results of this review show good to acceptable short and mid-term survival and good mid-term durability, which supports that ChEVAR as a suitable alternative in high-risk JAAA. However, proper patient selection for ChEVAR seems essential to attain good mid-term outcomes, and further large prospective and good quality studies are required to demonstrate its long-term results and enable conclusions on specific determinants for outcome.
概述烟囱式腔内修复术（ChEVAR）治疗近肾腹主动脉瘤（JAAA）的中期疗效相关文献。
检索不同电子数据库至2020年1月发表的文章。纳入标准为描述烟囱式腔内修复术治疗JAAA的中期或长期疗效（平均随访至少1年）的研究，包括超过10例病例，以英文发表且有全文。观察指标为总生存率、靶血管通畅率及3年无再次干预率。采用MINORS标准分析纳入研究的质量。使用随机效应模型分析合并效应估计值，并用I统计量检验异质性。
13篇文章符合纳入标准。纳入研究共描述了1019例患者。根据质量评估，方法学质量为中等至较差。3年的合并总生存率、无再次干预率和靶血管通畅率分别为81.4%（95%CI 73.8 - 87.9）、85.7%（95%CI 75.6 - 93.5）和95.1%（95%CI 89.3 - 98.7）。
本综述结果显示短期和中期生存率良好至可接受，中期耐久性良好，这支持ChEVAR作为高危JAAA的合适替代方案。然而，为ChEVAR选择合适的患者似乎对获得良好的中期疗效至关重要，需要进一步开展大型前瞻性高质量研究以证明其长期疗效，并得出关于疗效特定决定因素的结论。
